Skip to main content
Top
Published in: BMC Geriatrics 1/2011

Open Access 01-12-2011 | Research article

Analysis of frailty and survival from late middle age in the Beijing Longitudinal Study of Aging

Authors: Jing Shi, Xiaowei Song, Pulin Yu, Zhe Tang, Arnold Mitnitski, Xianghua Fang, Kenneth Rockwood

Published in: BMC Geriatrics | Issue 1/2011

Login to get access

Abstract

Background

Frailty in individuals can be operationalized as the accumulation of health deficits, for which several trends have been observed in Western countries. Less is known about deficit accumulation in China, the country with the world's largest number of older adults.

Methods

This study analyzed data from the Beijing Longitudinal Study of Aging, to evaluate the relationship between age and deficit accumulation in men and women and to evaluate the impact of frailty on mortality. Community dwelling people aged 55+ years at baseline (n = 3275) were followed every two to three years between 1992 and 2000, during which time 36% died. A Frailty Index was constructed using 35 deficits, drawn from a range of health problems, including symptoms, disabilities, disease, and psychological difficulties.

Results

Most deficits increased the eight-year risk of death and were more lethal in men than in women, although women had a higher mean level of frailty (Frailty Index = 0.11 ± 0.10 for men, 0.14 ± 0.12 for women). The Frailty Index increased exponentially with age, with a similar rate in men and women (0.038 vs. 0.039; r > 0.949, P < 0.01). A dose-response relationship was observed as frailty increased.

Conclusions

A Frailty Index employed in a Chinese sample, showed properties comparable with Western data, but deficit accumulation appeared to be more lethal than in the West.
Appendix
Available only for authorised users
Literature
1.
go back to reference Rockwood K, Fox RA, Stolee P, Robertson D, Beattie BL: Frailty in elderly people: an evolving concept. CMAJ. 1994, 150: 489-495.PubMedPubMedCentral Rockwood K, Fox RA, Stolee P, Robertson D, Beattie BL: Frailty in elderly people: an evolving concept. CMAJ. 1994, 150: 489-495.PubMedPubMedCentral
2.
go back to reference Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C: Frailty: an emerging research and clinical paradigm--issues and controversies. J Gerontol A Biol Sci Med Sci. 2007, 62: 731-737. 10.1093/gerona/62.7.731.CrossRefPubMedPubMedCentral Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C: Frailty: an emerging research and clinical paradigm--issues and controversies. J Gerontol A Biol Sci Med Sci. 2007, 62: 731-737. 10.1093/gerona/62.7.731.CrossRefPubMedPubMedCentral
3.
go back to reference de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW: Outcome instruments to measure frailty: A systematic review. Ageing Res Rev. 2011, 10: 104-114. 10.1016/j.arr.2010.09.001.CrossRefPubMed de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW: Outcome instruments to measure frailty: A systematic review. Ageing Res Rev. 2011, 10: 104-114. 10.1016/j.arr.2010.09.001.CrossRefPubMed
4.
go back to reference Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B: The assessment of frailty in older adults. Clin Geriatr Med. 2010, 26: 275-286. 10.1016/j.cger.2010.02.002.CrossRefPubMed Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B: The assessment of frailty in older adults. Clin Geriatr Med. 2010, 26: 275-286. 10.1016/j.cger.2010.02.002.CrossRefPubMed
5.
go back to reference Mitnitski A, Song X, Skoog I, Broe GA, Cox JL, Grunfeld E, Rockwood K: Relative fitness and frailty of elderly men and women in developedcountries andtheir relationship with mortality. J Am Geriatr Soc. 2005, 53: 2184-2189. 10.1111/j.1532-5415.2005.00506.x.CrossRefPubMed Mitnitski A, Song X, Skoog I, Broe GA, Cox JL, Grunfeld E, Rockwood K: Relative fitness and frailty of elderly men and women in developedcountries andtheir relationship with mortality. J Am Geriatr Soc. 2005, 53: 2184-2189. 10.1111/j.1532-5415.2005.00506.x.CrossRefPubMed
6.
go back to reference Goggins WB, Woo J, Sham A, Ho SC: Frailty index as a measure of biological age in a Chinese population. J Gerontol A Biol Sci Med Sci. 2005, 60: 1046-1051. 10.1093/gerona/60.8.1046.CrossRefPubMed Goggins WB, Woo J, Sham A, Ho SC: Frailty index as a measure of biological age in a Chinese population. J Gerontol A Biol Sci Med Sci. 2005, 60: 1046-1051. 10.1093/gerona/60.8.1046.CrossRefPubMed
7.
go back to reference Kulminski AM, Ukraintseva SV, Akushevich IV, Arbeev KG, Yashin AI: Cumulative index of health deficiencies as a characteristic of long life. J Am Geriatr Soc. 2007, 55: 935-940. 10.1111/j.1532-5415.2007.01155.x.CrossRefPubMedPubMedCentral Kulminski AM, Ukraintseva SV, Akushevich IV, Arbeev KG, Yashin AI: Cumulative index of health deficiencies as a characteristic of long life. J Am Geriatr Soc. 2007, 55: 935-940. 10.1111/j.1532-5415.2007.01155.x.CrossRefPubMedPubMedCentral
8.
go back to reference Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI: Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc. 2008, 56: 898-903. 10.1111/j.1532-5415.2008.01656.x.CrossRefPubMedPubMedCentral Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI: Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc. 2008, 56: 898-903. 10.1111/j.1532-5415.2008.01656.x.CrossRefPubMedPubMedCentral
9.
go back to reference Dupre ME, Gu D, Warner DF, Yi Z: Frailty and type of death among older adults in China: prospective cohort study. BMJ. 2009, 338: b1175-10.1136/bmj.b1175.CrossRefPubMedPubMedCentral Dupre ME, Gu D, Warner DF, Yi Z: Frailty and type of death among older adults in China: prospective cohort study. BMJ. 2009, 338: b1175-10.1136/bmj.b1175.CrossRefPubMedPubMedCentral
10.
go back to reference Gu D, Dupre ME, Sautter J, Zhu H, Liu Y, Yi Z: Frailty and mortality among Chinese at advanced ages. J Gerontol B Psychol Sci Soc Sci. 2009, 64: 279-289.CrossRefPubMed Gu D, Dupre ME, Sautter J, Zhu H, Liu Y, Yi Z: Frailty and mortality among Chinese at advanced ages. J Gerontol B Psychol Sci Soc Sci. 2009, 64: 279-289.CrossRefPubMed
11.
go back to reference Armstrong JJ, Stolee P, Hirdes JP, Poss JW: Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients. Age Ageing. 2010, 39: 755-758. 10.1093/ageing/afq121.CrossRefPubMed Armstrong JJ, Stolee P, Hirdes JP, Poss JW: Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients. Age Ageing. 2010, 39: 755-758. 10.1093/ageing/afq121.CrossRefPubMed
12.
go back to reference Rockwood K, Mitnitski A: Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011, 27: 17-26. 10.1016/j.cger.2010.08.008.CrossRefPubMed Rockwood K, Mitnitski A: Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011, 27: 17-26. 10.1016/j.cger.2010.08.008.CrossRefPubMed
13.
go back to reference Mitnitski A, Song X, Rockwood K: Improvement and decline in health status from late middle age: modeling age-related changes in deficit accumulation. ExpGerontol. 2007, 42: 1109-1115. Mitnitski A, Song X, Rockwood K: Improvement and decline in health status from late middle age: modeling age-related changes in deficit accumulation. ExpGerontol. 2007, 42: 1109-1115.
14.
go back to reference Mitnitski AB, Song X, Rockwood K: The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci. 2004, 59: M627-M632. 10.1093/gerona/59.6.M627.CrossRefPubMed Mitnitski AB, Song X, Rockwood K: The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci. 2004, 59: M627-M632. 10.1093/gerona/59.6.M627.CrossRefPubMed
15.
go back to reference Graham JE, Snih SA, Berges IM, Ray LA, Markides KS, Ottenbacher KJ: Frailty and 10-year mortality in community-living Mexican American older adults. Gerontology. 2005, 55: 644-651.CrossRef Graham JE, Snih SA, Berges IM, Ray LA, Markides KS, Ottenbacher KJ: Frailty and 10-year mortality in community-living Mexican American older adults. Gerontology. 2005, 55: 644-651.CrossRef
16.
go back to reference Song X, Mitnitski A, Rockwood K: Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010, 58: 681-687. 10.1111/j.1532-5415.2010.02764.x.CrossRefPubMed Song X, Mitnitski A, Rockwood K: Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010, 58: 681-687. 10.1111/j.1532-5415.2010.02764.x.CrossRefPubMed
17.
go back to reference Rockwood K, Mitnitski A: Limits to deficit accumulation in elderly people. Mech Ageing Dev. 2006, 127: 494-496. 10.1016/j.mad.2006.01.002.CrossRefPubMed Rockwood K, Mitnitski A: Limits to deficit accumulation in elderly people. Mech Ageing Dev. 2006, 127: 494-496. 10.1016/j.mad.2006.01.002.CrossRefPubMed
18.
go back to reference Ridda I, Macintyre CR, Lindley RI: A qualitative study to assess the perceived benefits and barriers to the pneumococcal vaccine in hospitalised older people. Vaccine. 2009, 27: 3775-3779. 10.1016/j.vaccine.2009.03.075.CrossRefPubMed Ridda I, Macintyre CR, Lindley RI: A qualitative study to assess the perceived benefits and barriers to the pneumococcal vaccine in hospitalised older people. Vaccine. 2009, 27: 3775-3779. 10.1016/j.vaccine.2009.03.075.CrossRefPubMed
19.
go back to reference Hubbard RE, Woodhouse KW: Frailty, inflammation and the elderly. Biogerontology. 2010, 11: 635-641. 10.1007/s10522-010-9292-5.CrossRefPubMed Hubbard RE, Woodhouse KW: Frailty, inflammation and the elderly. Biogerontology. 2010, 11: 635-641. 10.1007/s10522-010-9292-5.CrossRefPubMed
20.
go back to reference Woo J, Goggins W, Sham A, Ho SC: Public health significance of the frailty index. Disabil Rehabil. 2006, 28: 515-521. 10.1080/09638280500215867.CrossRefPubMed Woo J, Goggins W, Sham A, Ho SC: Public health significance of the frailty index. Disabil Rehabil. 2006, 28: 515-521. 10.1080/09638280500215867.CrossRefPubMed
21.
go back to reference Oksuzyan A, Crimmins E, Saito Y, O'Rand A, Vaupel JW, Christensen K: Cross- national comparison of sex differences in health and mortality in Denmark, Japan and the US. Eur J Epidemiol. 2010, 25: 471-480. 10.1007/s10654-010-9460-6.CrossRefPubMedPubMedCentral Oksuzyan A, Crimmins E, Saito Y, O'Rand A, Vaupel JW, Christensen K: Cross- national comparison of sex differences in health and mortality in Denmark, Japan and the US. Eur J Epidemiol. 2010, 25: 471-480. 10.1007/s10654-010-9460-6.CrossRefPubMedPubMedCentral
22.
go back to reference Jiang J, Tang Z, Meng XJ, Futatsuka M: Demographic determinants for change in activities of daily living: a cohort study of the elderly people in Beijing. J Epidemiol. 2002, 12: 280-286. 10.2188/jea.12.280.CrossRefPubMed Jiang J, Tang Z, Meng XJ, Futatsuka M: Demographic determinants for change in activities of daily living: a cohort study of the elderly people in Beijing. J Epidemiol. 2002, 12: 280-286. 10.2188/jea.12.280.CrossRefPubMed
23.
go back to reference Tang Z, Wang HX, Meng C, Wu XG, Kzerstin E, Bengt W, Pei JJ: The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese. Archives of Gerontology and Geriatrics. 1999, 29: 115-125. 10.1016/S0167-4943(99)00026-6.CrossRefPubMed Tang Z, Wang HX, Meng C, Wu XG, Kzerstin E, Bengt W, Pei JJ: The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese. Archives of Gerontology and Geriatrics. 1999, 29: 115-125. 10.1016/S0167-4943(99)00026-6.CrossRefPubMed
24.
go back to reference Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K: A standard procedure for creating a frailty index. BMC Geriatr. 2008, 8: 24-10.1186/1471-2318-8-24.CrossRefPubMedPubMedCentral Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K: A standard procedure for creating a frailty index. BMC Geriatr. 2008, 8: 24-10.1186/1471-2318-8-24.CrossRefPubMedPubMedCentral
25.
go back to reference Rothman MD, Leo-Summers L, Gill TM: Prognostic significance of potential frailty criteria. J Am Geriatr Soc. 2008, 56: 2211-2116. 10.1111/j.1532-5415.2008.02008.x.CrossRefPubMedPubMedCentral Rothman MD, Leo-Summers L, Gill TM: Prognostic significance of potential frailty criteria. J Am Geriatr Soc. 2008, 56: 2211-2116. 10.1111/j.1532-5415.2008.02008.x.CrossRefPubMedPubMedCentral
26.
go back to reference Dumurgier J, Elbaz A, Ducimetière P, Tavernier B, Alpérovitch A, Tzourio C: Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study. BMJ. 2009, 339: b4460-10.1136/bmj.b4460.CrossRefPubMedPubMedCentral Dumurgier J, Elbaz A, Ducimetière P, Tavernier B, Alpérovitch A, Tzourio C: Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study. BMJ. 2009, 339: b4460-10.1136/bmj.b4460.CrossRefPubMedPubMedCentral
27.
go back to reference Ling CH, Taekema D, de Craen AJ, Gussekloo J, Westendorp RG, Maier AB: Handgrip strength and mortality in the oldest old population: the Leiden 85-plus study. CMAJ. 2010, 182: 429-435. 10.1503/cmaj.091278.CrossRefPubMedPubMedCentral Ling CH, Taekema D, de Craen AJ, Gussekloo J, Westendorp RG, Maier AB: Handgrip strength and mortality in the oldest old population: the Leiden 85-plus study. CMAJ. 2010, 182: 429-435. 10.1503/cmaj.091278.CrossRefPubMedPubMedCentral
28.
go back to reference Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001, 56: M146-M156. 10.1093/gerona/56.3.M146.CrossRefPubMed Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001, 56: M146-M156. 10.1093/gerona/56.3.M146.CrossRefPubMed
29.
go back to reference Rockwood K, Andrew M, Mitnitski A: A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007, 62: 738-743. 10.1093/gerona/62.7.738.CrossRefPubMed Rockwood K, Andrew M, Mitnitski A: A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007, 62: 738-743. 10.1093/gerona/62.7.738.CrossRefPubMed
30.
go back to reference Kamaruzzaman S, Ploubidis GB, Fletcher A, Ebrahim S: A reliable measure of frailty for a community dwelling older population. Health Qual Life Outcomes. 2010, 8: 123-10.1186/1477-7525-8-123.CrossRefPubMedPubMedCentral Kamaruzzaman S, Ploubidis GB, Fletcher A, Ebrahim S: A reliable measure of frailty for a community dwelling older population. Health Qual Life Outcomes. 2010, 8: 123-10.1186/1477-7525-8-123.CrossRefPubMedPubMedCentral
31.
go back to reference Song X, Mitnitski A, MacKnight C, Rockwood K: Assessment of individual risk of death using self-report data: an artificial neural network compared with a frailty index. J Am Geriatr Soc. 2004, 52: 1180-1184. 10.1111/j.1532-5415.2004.52319.x.CrossRefPubMed Song X, Mitnitski A, MacKnight C, Rockwood K: Assessment of individual risk of death using self-report data: an artificial neural network compared with a frailty index. J Am Geriatr Soc. 2004, 52: 1180-1184. 10.1111/j.1532-5415.2004.52319.x.CrossRefPubMed
32.
go back to reference Rockwood K, Rockwood MR, Mitnitski A: Physiological redundancy in older adults in relation to the change with age in the slope of a frailty index. J Am Geriatr Soc. 2010, 58: 318-323. 10.1111/j.1532-5415.2009.02667.x.CrossRefPubMed Rockwood K, Rockwood MR, Mitnitski A: Physiological redundancy in older adults in relation to the change with age in the slope of a frailty index. J Am Geriatr Soc. 2010, 58: 318-323. 10.1111/j.1532-5415.2009.02667.x.CrossRefPubMed
33.
go back to reference Rockwood K, Song X, Mitnitski A, Yu PL: Geriatric medicine and the care of frail elderly people. Chin J Geriatr. 2009, 28: 353-365. Rockwood K, Song X, Mitnitski A, Yu PL: Geriatric medicine and the care of frail elderly people. Chin J Geriatr. 2009, 28: 353-365.
34.
go back to reference Song X, Mitnitski A, Shi J, Yu PL, Fang XH, Tang Z, Rockwood K: Quantification of health and ageing in Canada and China: a Canada-China joint health research initiative project. Chin J Geriatr. 2009, 28: 793-802. Song X, Mitnitski A, Shi J, Yu PL, Fang XH, Tang Z, Rockwood K: Quantification of health and ageing in Canada and China: a Canada-China joint health research initiative project. Chin J Geriatr. 2009, 28: 793-802.
Metadata
Title
Analysis of frailty and survival from late middle age in the Beijing Longitudinal Study of Aging
Authors
Jing Shi
Xiaowei Song
Pulin Yu
Zhe Tang
Arnold Mitnitski
Xianghua Fang
Kenneth Rockwood
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2011
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-11-17

Other articles of this Issue 1/2011

BMC Geriatrics 1/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine